Medicare pays a neurology practice to manage a complex neurological condition between visits through Principal Care Management. This is the 24-month plan to bill it across the practice's Medicare patients, inside Greenway Intergy, with the practice's neurologists and APPs referring patients at the visit and CoachCare's care team doing the monthly work under their supervision. Flat fees per block of care time, no platform fee, no capital, no new hires.
Clinical Neurology Specialists built its name on getting the diagnosis right, with AANEM-accredited electrodiagnostic labs in both offices and a full in-office testing menu. Most of what follows a diagnosis of epilepsy, Parkinson's disease, multiple sclerosis, dementia or chronic migraine happens between appointments: the missed dose, the fall, the new symptom, the caregiver who needs a call back. Medicare pays for that work every month through Principal Care Management. At CNS it is not yet a service line.
Five board-certified neurologists and four advanced practice providers across the Las Vegas and Henderson offices. The program is built on their referrals: a flag in Intergy at the visit, when the diagnosis and the plan are fresh, is the whole enrollment step for the clinician.
CY2024 Medicare claims for the neurologists billing at the practice's two addresses show hypertension in three of four beneficiaries or more, diabetes in 37%, ischemic heart disease in 32%, chronic kidney disease in 25% and depression in 25%. Average age 73, average risk score 1.26 against a national 1.00.
Fellowship-trained epilepsy care with VNS and DBS device management, movement disorders, multiple sclerosis with an MS-certified nurse, memory evaluations at an active Alzheimer's research site, and headache medicine. Each one is a condition-specific care pathway waiting to be run month to month.
Two decades of the practice's history live in one Intergy chart, with Greenway's patient portal already in use. CoachCare's integration with Intergy is the one Greenway itself offers its customers for care coordination, so the program runs inside the system the practice already uses.
One structural fact completes the picture: no principal care management or other care-management code appears at meaningful scale in the practice's CY2024 Medicare claims. The neurologists billed 22 distinct services that year, visits and in-office diagnostics. The conditions are in the chart. The monthly management of them is not yet billed.
Principal Care Management covers a single complex chronic condition, expected to last at least three months, that puts the patient at risk and needs a disease-specific care plan. That describes most of the practice's established epilepsy, Parkinson's, multiple sclerosis, dementia and migraine patients. The neurologist owns the plan; CoachCare's clinical staff deliver the monthly time under the neurologist's supervision.
The first 30 minutes of clinical-staff time in a calendar month pays $67.45 in Nevada. Time under 30 minutes is not billable, so the care team plans each month to clear it: a call, a care-plan update, coordination with the office.
Patients who need more in a month, a medication change, a new symptom, a caregiver who needs more support, add $53.86 in Nevada for each further 30 minutes of clinical-staff time.
Care managers, enrollment outreach, documentation and billing preparation are CoachCare's payroll. CoachCare charges a flat fee per 30-minute block of care delivered and nothing per enrolled patient. The one-time charges are implementation and the Intergy setup, plus a small fee per new enrollment.
Medicare Advantage covers about 57% of Clark County's 431,000 Medicare beneficiaries (CMS, October 2026). MA plans must pay at least the Medicare rate, a floor; individual contracts set their own terms for the care-management code families. The forecast prices every patient in scope at the Medicare fee schedule. Which plans hold the practice's Medicare patients, and how each one pays for PCM, is the second thing to confirm after the patient count.
A named PCM service line with its own P&L and monthly scorecard, run inside Greenway Intergy. Clinical Neurology Specialists owns the program, its protocols, its patients and its revenue. CoachCare's care team does the monthly work under the general supervision of the practice's clinicians, using a care pathway built around each condition.
Seizure log and trigger review, medication adherence and refill gaps, side effects, the rescue-medication plan, and VNS follow-up on schedule.
Dose timing against symptoms, a fall screen every month, swallowing and mood checks, and therapy referrals tracked to completion.
Disease-modifying therapy adherence, infusion and lab scheduling, and new or worsening symptoms routed to the practice's MS nurse.
Calls that include the caregiver, home-safety and wandering screens, behavioral symptoms escalated early, and advance-care-planning prompts.
Headache days tracked against the preventive plan, the Botox and CGRP schedule kept, and medication overuse caught before the next visit.
Secondary stroke prevention between visits: antithrombotic and statin adherence, blood pressure follow-up with the patient's other physicians, and new deficits escalated the same day.
| Service | Codes | CY2026, Nevada | Use across the panel |
|---|---|---|---|
| Principal care management, first 30 minutes | 99426 | $67.45 | One complex neurological condition; disease-specific care plan |
| Principal care management, each additional 30 minutes | 99427 | $53.86 | Months that need more than 30 minutes of clinical-staff time |
CY2026 Physician Fee Schedule non-facility amounts for Nevada (Noridian, locality 00, which covers both offices), the basis the Value Analysis below is priced on.
A clinician marks a patient enrolled, declined or opted out with an Intergy flag and signs the note. From there the patient's demographics, problem list with the ICD-10 codes the billing team maintains, medications, history and recent encounter notes flow to the care team, including the free-text notes the neurologists dictate. Every closed encounter sends an updated record, so the care plan keeps pace with the chart. Charges come back into Intergy by about the fifth business day of the following month, and a monthly care summary posts to the patient's chart a day or two later as the documentation behind the claim.
Enrollment is an Intergy flag and a signed note, set up with the practice's staff during training. No referral fax, no separate portal.
Charges arrive in Intergy early in the following month and go through the review the practice's billers already run.
A monthly care summary for every enrolled patient posts to the chart, so every claim has its documentation where an auditor would look.
A healthcare attorney reviewing a care-management partner asks four questions: who furnishes the service and under whose supervision, what proves it happened, how the partner is paid, and what happens to the patient's share. Here is how this program answers each one.
Medicare lets the clinical-staff time in Principal Care Management be furnished under the billing practitioner's general supervision, which does not require the practitioner to be on site. Its definition of the staff who may do that work covers independent contractors and the companies that employ them, not only the practice's own employees, and CMS's care-management guidance names an outside case management company as an acceptable source of clinical-staff time when the incident-to rules are met. What Medicare asks in return is real oversight and clinical integration: the practice's clinicians order the service, own the care plan, stay involved month to month, and the claims go out under the practice's own enrollment. The Intergy integration is what makes that oversight visible in the chart.
42 CFR 410.26(a)(1), (a)(4) and (b)(5); CY2020 Physician Fee Schedule final rule, 84 FR 62696; CMS Chronic Care Management FAQs.Consent is captured and filed before the first billed month. The care plan lives in the chart. Time is logged by staff member, date and activity. A monthly care summary for every enrolled patient posts to Intergy next to the charge it supports, and the record updates with every closed encounter. The evidence sits in the practice's own chart, not in a vendor portal that has to be requested.
A flat fee per completed 30-minute block of care time, with no per-patient platform fee, and never a percentage of what the practice bills or collects. The fee does not move with the practice's collections or with Medicare's payment. Month to month the margin holds steady whether CNS has 200 patients enrolled or 1,000.
Patients receive a statement for their 20% share as with any Part B service. A Medigap plan covers it for patients who carry one, and Qualified Medicare Beneficiaries owe nothing. Medicare does not allow the share to be waived routinely, and the program never asks the practice to. The regulation's own exception covers balances written off after reasonable collection efforts or a good-faith finding of financial need, and the consent conversation explains the monthly charge before the first billed month, so the statement arrives expected.
OIG Special Fraud Alert, Routine Waiver of Copayments or Deductibles Under Medicare Part B (59 FR 65372); 42 CFR 1003.110; CMS Chronic Care Management FAQs.A 24-month forecast for Principal Care Management across 2,000 active Medicare patients, the practice's own working estimate, enrolled through referrals from the practice's 9 neurologists and APPs, Nevada rates, the Greenway Intergy integration, and half of patient coinsurance collected. Every patient is priced at the Medicare fee schedule; in a county where about 57% of Medicare beneficiaries are in Medicare Advantage, that rate is a floor for MA members and each plan's contract sets its own terms for these codes.
| Program | Net reimbursement | CoachCare fees | Net to practice |
|---|---|---|---|
| PCM: principal care management | $808,796 | $422,000 | $386,796 |
| Implementation, Intergy integration and enrollment outreach | — | $11,438 | −$11,438 |
| 24-month total | $808,796 | $433,438 | $375,358 |
| CoachCare PCM fees: $30 for the first 30 minutes in a month, $26 for each additional 30, no per-patient platform fee. | |||
| The care managers and the enrollment outreach team are CoachCare's expense: embedded in the fee, never deducted from the practice's margin. | |||
24-month practice margin: 46.4% of net reimbursement (Year 1 44.1%, Year 2 47.6%).
Year 1 is $125,253 net to the practice on $283,902 of net reimbursement; Year 2 is $250,105 on $524,893. Month 1 is −$4,439; every month after it is positive.
Every month from month 11, each with a disease-specific care plan, a monthly call and a care manager who knows the case.
Recurring professional-fee volume over 24 months, prepared for the practice's billers inside Intergy.
Outreach, care planning and documentation over 24 months, carried by the service line rather than the offices' medical assistants.
The staffing the practice would otherwise recruit, train and manage to run the program itself.
Medicare pays 80% of the allowed amount and the patient owes the other 20%, unless a supplemental plan picks it up. On a fixed-income Medicare panel some of that share never arrives. This forecast assumes the practice collects about half of it. Here is the same 24 months at four collection rates, with everything else held equal.
The spread between collecting everything and collecting nothing is $179,732 over two years. The program needs no change to the practice's collection policy to work. The Scenario Explorer above has a coinsurance slider for any rate in between.
On the clinicians' referrals alone, PCM fills its eligible pool of 510 patients in month 11 and holds there for the rest of the 24 months. How fast it gets there is the referral habit: at 10 referrals per clinician a month it fills by month 9 and the practice nets $394,861; at 6 a month it takes until month 14 and nets $343,157. How high it goes is the count of active Medicare patients in scope.
| Referrals per clinician per month | Pool full by | 24-mo net reimb. | 24-mo net to practice |
|---|---|---|---|
| 6 | Month 14 | $741,216 | $343,157 |
| 8 (this forecast) | Month 11 | $808,796 | $375,358 |
| 10 | Month 9 | $849,727 | $394,861 |
| Medicare patients in scope | Patients enrolled | Pool full by | 24-mo net to practice |
|---|---|---|---|
| 1,500 | 383 | Month 9 | $298,375 |
| 2,000 (this forecast) | 510 | Month 11 | $375,358 |
| 3,000 | 765 | Month 16 | $492,686 |
| 4,000 | 1,020 | Month 21 | $560,200 |
Each row is a full recalculation of the Value Analysis workbook. PCM eligibility is 85% of patients in scope, with 30% of eligible patients accepting; 9 referring clinicians.
The first lever is the flag at the visit. Every neurologist and APP who makes it routine moves the forecast; with all nine referring, the pool fills in month 11, and with the five neurologists alone it takes until month 19. The second lever is the count: the 2,000 on this page is a deliberately round working figure built from the practice's monthly visit volume and Medicare share, and a report of patients seen in the last twelve months or scheduled in the next twelve replaces it. With a larger count, referral pace decides most of the two years: a 3,000-patient pool takes until month 16 to fill and a 4,000-patient pool until month 21. The third is the payer split: with about 57% of Clark County's Medicare beneficiaries in Medicare Advantage, each plan's terms for PCM decide what its members bring to the program.
New patients enter the practice every month, and each one with a chronic neurological diagnosis becomes a referral after the first visit. The forecast holds the in-scope count flat for two years. A growing practice will not.
CoachCare runs the service line's engine while the practice's clinicians govern the protocols and every clinical decision. Full-service delivery means launch needs no new headcount; the Intergy setup runs alongside onboarding, and the first enrollments follow the first patients the clinicians flag.
Intergy enrollment flags configured with the practice's staff; the billing workflow agreed with the billing team; a named program lead; protocol sign-off for the epilepsy, Parkinson's, MS, dementia, headache and stroke-prevention PCM pathways; consent language and patient materials in the practice's branding.
Neurologists and APPs at both offices flagging eligible patients at the visit; CoachCare calling each referral within days; the first care plans and monthly calls; escalation routes tested with each office.
Referrals bring PCM to the modeled 510 patients by month 11; a monthly referral report by clinician; first charges reviewed against the forecast; the monthly P&L review with the customer success advisor begins.
Replace the working estimate with the Intergy count, extend the program to new patients as they are diagnosed, and refine eligibility by condition against what the claims show.
The CY2027 proposed fee schedule made headlines for its cuts to remote monitoring. This service line bills principal care management only. Here is what the proposal does to the forecast on this page, priced at the Nevada amounts the forecast runs on.
The steep reductions fall on the remote-monitoring device-supply codes, about −21% on 99454 at the Nevada amount. Principal care management is not targeted. It moves only through the conversion factor and routine relative-value updates.
Repricing both PCM codes at the proposed CY2027 Nevada amounts takes $3,775 off $808,796 of 24-month net reimbursement, −0.47%. The first-30-minute code moves down slightly and the add-on code moves up.
A care-management service line built on staff time, not devices, sits outside the part of the fee schedule CMS is reworking. For a neurology practice choosing where to start, that is a steadier base than a device-led program.
The bar is the full 24-month service line; the sliver at its end is the proposed reduction, drawn to scale.
24-month net reimbursement, CY2026 final versus CY2027 proposed, every code repriced at Noridian Nevada locality 00 amounts, non-facility, on this forecast's own billing mix. Enrollment, acceptance and mix held constant. This is the rate change alone.
National non-facility amounts from the proposed rule's Addendum B, so the movement can be read without a locality in the way. The repricing above uses Nevada amounts; the two bases do not reconcile to the dollar, by design.
| In this service line: care management | ||||
|---|---|---|---|---|
| Code | What it pays for | CY2026 | CY2027 | Change |
| 99426 | Principal care management, first 30 minutes | $67.80 | $67.00 | −1.2% |
| 99427 | Principal care management, each additional 30 minutes | $54.11 | $54.52 | +0.8% |
| Not in this service line: remote monitoring | ||||
| 99454 | Remote monitoring device supply, 16–30 days | $52.11 | $41.38 | −20.6% |
| 99445 | Remote monitoring device supply, 2–15 days | $52.11 | $41.38 | −20.6% |
| 99457 | Remote monitoring treatment management, first 20 minutes | $51.77 | $49.59 | −4.2% |
The comment period on CMS-1848-P closed on September 14, 2026. The final rule publishes in early November 2026 and takes effect January 1, 2027. CoachCare will rerun this forecast against the final rates the week they publish.
The service line on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers running remote care programs day to day.
Programs stood up and running in market.
Care-plan coding and billing behind more than 5 million claims.
More than 4 million care actions enabled across the platform.
Six reasons this partnership fits Clinical Neurology Specialists specifically.
CoachCare is the care-coordination integration Greenway provides to Intergy practices. Enrollment flags go out, and charges, care summaries, enrollment status and tasks come back into Intergy. Clinicians keep dictating the way they do now, and nobody re-keys a note.
Care managers at about 160 patients each, an outreach team that calls every referral within days, documentation and billing preparation are CoachCare's payroll. The clinician's part is the flag at the visit. The program lands at a 46.4% margin to the practice over 24 months.
Consent, care plan, time logs and a monthly care summary filed in the practice's own chart for every patient, every month. For a practice that wants every Medicare claim provable, the paper trail is built in rather than assembled after the fact.
$30 for the first 30 minutes of PCM care in a month and $26 for each additional 30, with no per-patient platform fee. Fees do not rise with the practice's collections, and the margin holds steady as enrollment grows.
Monthly work runs on task-based pathways for each condition: seizure logs and rescue plans, dose timing and fall screens, therapy adherence, caregiver calls. The practice's clinicians sign off on every pathway before launch.
Ninety days' notice to end it, and the practice can tell CoachCare to unenroll any patient at any time. A dedicated customer success advisor reviews the service line's P&L every month so the margin on this page is the margin the practice sees.